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Marek P. Ehrlich
Alfred A. Kocher
Ernst Wolner
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Ann Thorac Surg 2002;73:1843-1848
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Surgical treatment of acute type a dissection: is rupture a risk factor?

Marek P. Ehrlich, MD*a, Martin Grabenwöger, MDa, Juliane Kilo, MDa, Alfred A. Kocher, MDa, Georg Grubhofer, MDb, Andrea M. Lassnig, MDb, Edda M. Tschernko, MDb, Bernhard Schlechta, MDa, Doris Hutschala, MDa, Hans Domanovits, MDc, Gottfried Sodeck, MDa, Ernst Wolner, MDa

a Departments of department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
b Department of Cardiac Anesthesia, University of Vienna, Vienna, Austria
c Department of Emergency Care, University of Vienna, Vienna, Austria

Accepted for publication February 17, 2002.

* Address reprint requests to Dr Ehrlich, Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Viennam, Austria
e-mail: marekehrlich{at}hotmail.com

Background. The purpose of this study was to evaluate the significance of aortic rupture on clinical outcome in patients after aortic repair for acute type A dissection.

Methods. One hundred and twenty patients underwent aortic operations with resection of the intimal tear and open distal anastomosis. Median age was 60 years (range 16 to 87); 78 were male. Thirty-six patients had only ascending aortic replacement, 82 had hemiarch repair, and 2 had the entire arch replaced. Retrograde cerebral perfusion was utilized in 66 patients (53%). Rupture defined as free blood in the pericardial space was present in 60 patients (50%). Univariate and multivariate analyses were performed to assess the risk factors for mortality and neurologic dysfunction.

Results. Overall hospital mortality rate was 24.2% ± 4.0% (± 70% confidence level) but did not differ between patients with aortic rupture or without (p = 0.83). The incidence of permanent neurologic dysfunction was 9.4% overall, 10.5% with rupture and 8.3% without rupture (p = 0.75). Multivariate analysis revealed absence of retrograde cerebral perfusion and any postoperative complication as statistically significant indicators for in-hospital mortality (p < 0.05). Overall 1- and 5-year survival was 85.3% and 33.7%; among discharged patients, survival in the nonruptured group was 89% and 37%, versus 81% and 31% in the ruptured group (p = 0.01).

Conclusions. Aortic rupture at the time of surgery does not increase the risk of hospital mortality or permanent neurologic complications in patients with acute type A dissections. However, aortic rupture at the time of surgery does influence long-term survival.






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